1. Field of the Invention
The present invention generally relates to detecting the potential for fraud. In particular, embodiments relate to systems and methods of assessing fraud potential in multiple industries.
2. Description of the Related Art
While fraud affects many companies, it may be difficult to detect. For example, insurance fraud may be difficult to detect because insurance criminals may not be easily identifiable. Insurance criminals may range from organized fraud rings to dishonest individuals. Other types of fraud may include mortgage loan fraud, banking fraud, and health care fraud.
Furthermore, property and casualty insurers typically rely on adjustors and special investigation units (SIUs) within their companies to investigate potentially fraudulent requests (e.g., insurance claims, bank checks, loan applications, and health care billing—i.e., “requests” for financial transactions from customers of a financial institution). Insurance companies, banks, and mortgage lenders, however, may have a limited number of adjusters and investigators. Therefore, it may not be feasible to manually investigate every request filed for fraudulent activity.
Some methods for detecting the potential for fraud have focused on identifying a subset of requests for investigation that have a high potential for fraud. Such methods may make use of insurance industry databases that have been developed to assist in detecting the potential for fraud. For example, the National Insurance Crime Bureau (NICB) of Palos Hills, Ill. compiles a database of insurance claim data from member property and casualty insurance companies that insurance companies can access to determine if one of their current claims is potentially fraudulent. The NICB database includes suspicious requests that have been submitted to all participating insurance companies. In addition, ISO of Jersey City, N.J. provides a product, ISO requestSearch™, that includes databases for insurance claim data. There is generally incentive to identify only requests with the greatest potential of fraud to reduce the “false-positive” rate. Such a system may reduce time spent on human analysis while also reducing the costs to the company of fraudulent requests.